NHS England has revealed more details about a controversial national pilot to ‘further deliver’ on the Fuller stocktake, including which PCNs will be taking part.
Earlier this year, Pulse reported on NHS England’s new pilot scheme which will give a number PCNs a 10% funding uplift for more GP clinical staff to ‘accelerate’ delivery of the long-term workforce plan.
The scheme, which has been heavily criticised by GP leaders who claimed it will be putting ‘excessive’ conditions on practices, is designed to ‘test’ whether implementing the long-term workforce plan, along with other digital tools such as process automation, can plug gaps in general practice capacity.
The test sites, based in seven different ICBs across England, will gather extensive data to understand whether these interventions make a difference compared with the current ‘baseline’ and this will help to ‘further deliver’ on the 2022 Fuller stocktake, according to NHS England.
Now, in a document seen by Pulse, the commissioner has revealed the 22 PCNs that will take part in the pilot.
These are:
- Meridian Health Group (Humber and North Yorkshire)
- Whitby Coast & Moors (Humber and North Yorkshire)
- Holderness Primary Care Home (Humber and North Yorkshire)
- South Hambleton & Ryedale (Humber and North Yorkshire)
- Colchester Medical Group (Suffolk and North East Essex)
- Ranworth (Suffolk and North East Essex)
- Barrack Lane & Ivry Street (Suffolk and North East Essex)
- Tendring (Suffolk and North East Essex)
- Townships 1 (South Yorkshire)
- Rother Valley South (South Yorkshire)
- Seven Hills (South Yorkshire)
- GPA 1 (South Yorkshire)
- Frome (Somerset)
- Mendip (Somerset)
- Cheltenham Central (Gloucestershire)
- Rosebank (Gloucestershire)
- West and Central (North Central London)
- Barnet 3 (North Central London)
- Kentish Town South (North Central London)
- Lincoln Health Partnership (Lincolnshire)
- IMP (Lincolnshire)
- APEX (Lincolnshire)
NHS England said that at the heart of the plan was ‘a standardised approach that uses digital tools to support triage of requests based on clinical need’ and that the pilot will ‘gather insights on this’.
It added: ‘In practices that have adopted this model, patients have the choice to contact them online, by phone or in person. There are efficiencies in this model.
‘But do these practices now have the capacity to deliver all the proactive and preventative care we ask of them, achieve good levels of care continuity for those who would benefit the most, or be able to lead or contribute to neighbourhood working? If not, what resource is needed?
‘And do patients report positive experiences and staff feel the model is sustainable for them? This programme aims to help answer these questions.
‘The seven ICBs will work with 22 PCN test sites, covering around 1 million patients, to generate the necessary data insights.’
The commissioner also said that the programme will begin by establishing a ‘clear data baseline’, as part of a ‘before and after’ approach to test out the changes.
In particular, the pilot will involve:
- ICBs working through the variations in direct and indirect spend on primary care services to ‘understand the impact’ on overall general practice income, capacity and workload
- PCN test sites conducting three separate audit weeks of ‘intensive’ data collection at the practice and PCN level
- Gathering of system performance data – data on the activity of 111 calls, A&E attendance and Pharmacy First and requests through referral activity
- PCN test sites sharing data on the total income and costs for the PCN and each practice, and the proportion focused on GMS/PMS/APMS and PCN DES delivery.
After the baseline has been established, the PCNs will develop changes that they want to test and measure the impact across five possible areas (see box), and these will then discussed at a workshop in December.
Initial intervention areas
1. Optimising key aspects from PCARP
• Expanding the uptake of the NHS App and Pharmacy First.
• Improving communication to patients about the primary care workforce and digital
channels.
• Ways to reduce the workload, clinical and administrative, across the primary-secondary
care interface.
2. Advancing Modern General Practice beyond PCARP
• Implement digital methods for risk stratification and repetitive process automation
tools to reduce administrative workload and better utilise resource.
• Achieving higher levels of care continuity for patients who would benefit the most,
and how best to measure continuity in modern ways of working.
3. Enhancing proactive population health management (PHM)
• Implement agreed key actions for effective PHM, such as identifying patient
searches for case or medication reviews (e.g. CQC searches, CVDPREVENT
reviews, frequent fliers).
4. Define and apply best practices for MDTs for complex cohorts
• With input from national clinical directors, define and measure the impact of MDTs
for complex cohorts by 2025/26.
5. Increasing clinical capacity
• Funding to increase clinical capacity as outlined in the LTWP for 2028/29
(approximately a 10% increase).
Source: NHSE
Up to March 2027, the commissioner will provide additional funding to the seven ICBs through adjustments to primary care allocations, and the ICBs will pass most of this funding to PCNs, NHS England added.
NHS England said: ‘Our goal is to support the sustainability of general practice: the bedrock of our NHS.
‘When we first announced the PCN Test Site programme in May 2024, we described how this will help respond to the challenges and pressures that PCNs and their practices are facing.
‘Anecdotal feedback is telling us there is a demand and capacity gap which is making it hard for general practice to continue in a sustainable way.
‘Our aim is to work with general practice to collect the necessary information and data that will give us a better and shared understanding of the gap, the causes and the solutions.’
The BMA GP Committee England and a group of LMCs have highlighted several issues with NHS England’s plan, including its potential to worsen health inequalities and the requirements to share income data.
And one of the options for GP collective action, which began at the start of August, is for ‘practices to delay signing up to any local or national pilot schemes until the dispute is resolved’, including this specific pilot.
Not sure we need radical changes to the GP operating model, only to the way PCNs are only ever trying to squeeze more work than is possible out of GPs with ever-decreasing funding.
But are these actually going to look at any GP operating models, or only going to tweak at the edges to try to get more service for less money out of GPs yet again?
9 years ago I wrote to our commissioners with the results of our total triage model. At least 20% extra funding was the figure to get close to meeting actual demand.
Now it would be more like 40% given the extra demand from other failing services.
10% is just about enough to tread water.
Show me the business case at a practice and PCN level demonstrating current average capacity and cost per encounter/type of encounter/follow up work related to encounter (number/type/duration and type of clinician undertaking appointment) and then show me what NHSE anticipates achieving with a 10% uplift to ‘some funding’ – is it GMS funding, ARRS/IIF/QOF/PCN funding – and what are the measurable data? I suspect the conclusions have already been reached by NHSE and the data measured will be such that the type (i.e medical qualification) of clinician, the type and complexity of the encounters and the subsequent encounters generated by the initial consultation will be rather intractable.
As Jerry Mcguire once said “show me the money, Show Me the Money, SHOW ME THE MONEY”. if only they would fund general practice on true activity rather than the very cheap buffet price tag with the expectation of very high quality food unlimited food and drink, we wouldn’t be where we are.